CASE OF THE MONTH

Ulcer with Fungal Elements

A 75 year old gentleman presented with a persistent left buccal mucosal ulcer and a left mandibular alveolar wound, both highly suspicious for neoplasm. Biopsies from both showed ulcerated mucosa with acute, chronic, and granulomatous inflammation. There was no evidence of malignancy, including by immunoperoxidase (pancytokeratin) stain. Histochemical stains (GMS and PAS) highlighted the presence of numerous fungal elements within macrophages. The fungal elements (yeast forms) measured approximately 2-3 microns and were morphologically suggestive of histoplasmosis.